Sammy D Eghbalieh, MD, Kenneth R Ziegler, MD, Mackenzie L Bear, MSC, Giang T Bui, BS, Andrew Ferrante, Babak Eghbalieh, MD FACS, Michael S Ajemian, MD FACS. Saint Mary’s Hospital – Yale Affiliate, Waterbry, CT; Yale University School of Medicine, New Haven, CT; UCSF Fresno Department of Surgery, UCSF Medical Education Program, Fresno, CA USA
Introduction: Percutaneous endoscopic gastrostomy (PEG) tube is widely used in patients of all age groups who require alternative nutritional support. However, the use of PEG tubes has become a controversial issue particularly among the geriatric population residing in nursing homes who suffer from severe dementia. Grant and Rudberg showed that the majority of these patients failed to achieve any meaningful improvement in nutritional status, functional status, or subjective benefit after the placement of PEG. Furthermore, Grant and Rudberg demonstrated a 30-day mortality of 23.9% in this geriatric population. There is a paucity of literature exploring why this patient population has such a poor outcome after PEG tube placement. This study hypothesizes that malnourished patients experience a higher number of post-PEG tube placement complications.
Methods: Retrospective chart review of 427 subjects from January 2000 thru August 2010 at a community-based teaching hospital was conducted. Mean age was 75 years old. Nutritional status was measured by preoperative albumin levels. Albumin levels were defined as normal to be ≥3.51 g/dl, mildly malnourished ≥3.01 – 3.50g/dl, moderately malnourished ≥2.51 – 3.00g/dl, severely malnourished ≤2.50g/dl. Post PEG tube placement complications which required tube replacement either percutaneously or operatively were analyzed. T-test statistical analysis was performed (p<0.05).
Results: Ten percent of patients (38/380) had post-operative complications, which required replacement of the gastrostomy tube. Eighty-nine percent of these patients (34/38) were malnourished. Severely malnourished patients (25/38) were found to have the most complications, when compared to moderately malnourished (4/38) and mildly malnourished (5/38) patients respectively (p<0.05).
Conclusions: Malnourished patients have significantly higher rate of complications requiring gastrostomy tube replacement when compared to patients with adequate pre-operative nutritional status. We recommend that malnourished patients receive nutritional support via other means (i.e. naso-enteric feeding tube or hyperalimentation) prior to PEG tube placement. Further investigation is recommended to evaluate the efficacy of this practice.
Program Number: P473